نشریه راهبردهای مدیریت در نظام سلامت
پیاپی 1 (پاییز 1395)

The problems associated with cerebral palsy and their socio-economic burden impose a large pressure on families with children suffering from cerebral palsy. This study aimed to compare clinic care and home care regarding costs of treatment for children with cerebral palsy.
This cross-sectional study was conducted on 56 children
with cerebral palsy. Data were collected by direct costs through medical and non-medical checklists and analyzed using descriptive statistics (frequency, mean, and standard deviation) and T-test.
The cost of home care was less than clinic care (P>0.01). Price differences in home and clinic care was significant in all types of cerebral palsy. In both groups of the children, the highest average fee belonged to those who were not covered by any insurance. The average cost of care in clinic was 8,543,000 Rials while it was 5,497,000 Rials for home care. The average total cost of care was 19,786,000 Rials at home and 27,980,000 Rials at the clinic (P>0.05).
The cost of clinic care was higher than home care. Therefore, home care is recommended as the appropriate and more cost-effective strategy for children with cerebral palsy. Considering the Problems of home care, it is essential to facilitate implementation of this strategy by improving insurance coverage and informing families with cerebral palsy children.

To maintain their survival, organizations are forced to keep pace with the changes that occur. Participative management could be one way of reducing resistance to change by increased participation and commitment of the employees. The present study aimed to evaluate the relationship between participative management and resistance to change from the perspective of administrators at educational hospitals of Yazd in 2013.
This was a cross-sectional and analytical study performed in 2013. The subjects consisted of 81 senior, middle, and operational managers working in educational hospitals of Yazd Shahid Sadoughi University of Medical Sciences. Data were gathered through two questionnaires of participative management (19 questions) and resistance to change (13). The reliabilities were assessed by Cronbach's alpha coefficient to be 78% and 70%, respectively. The data were analyzed using SPSS 19, ANOVA, and Pearson correlation coefficient test.
The findings showed an inverse relationship between participative management and resistance to change which was meaningful (P 0.05, r = -0.3). Also, two parameters of participative management including participation in implementation (P = 0.004, r = -0.325), and control and supervision (P = 0.01, r = -0.292) indicated an inverse significant correlation with resistance to change.
According to the results of this study applying participative management could be an appropriate and beneficial strategy to reduce staff resistance to change.

Hospital managers need to have accurate information about actual costs to make efficient and effective decisions. In activity based costing method, first, activities are recognized and then direct and indirect costs are computed based on allocation methods. The aim of this study was to compute the cost price for cataract surgery by Activity Based Costing (ABC) method at Hazrat-e-Zahra Hospital, Isfahan University of Medical Sciences.
This was a cross- sectional study for computing the costs of cataract surgery by activity based costing technique in Hazrat-e-Zahra Hospital in Isfahan University of Medical Sciences, 2014. Data were collected through interview and direct observation and analyzed by Excel software.
According to the results of this study, total cost in cataract surgery was 8,368,978 Rials. Personnel cost included 62.2% (5,213,574 Rials) of total cost of cataract surgery that is the highest share of surgery costs. The cost of consumables was 7.57% (1,992,852 Rials) of surgery costs.
Based on the results, there was different between cost price of the services and public Tariff which appears as hazards or financial crises to the hospital. Therefore, it is recommended to use the right methods to compute the costs relating to Activity Based Costing. Cost price of cataract surgery can be reduced by strategies such as decreasing the cost of consumables.

The present study aimed to determine the asociation between organizational commitment of the nurses and quality of hospital services at Women's Hospital of Tehran.
This was an analytical, cross-sectional, and practical study in which 75 nurses and 187 patients were randomly selected from Women's Hospital wards. Data collection was done through two standard questionnaires. Statistical analysis was performed using correlation tests and one-way ANOVA by SPSS20.
According to the results of this study, normative commitment was statistically associated with the quality of services (P = 0.03; r = 0.33) as well as its two dimensions of guarantee (P = 0.04; r = 0.35) and reliability (P = 0.05; r = 0.34). Also a significant positive relationship was found between the continuance commitment and reliability (P = 0.04; r = 0.30).
Considering the correlation of normative and continuance commitments with some dimentions of the quality of hospital services it seems that planning and action twards improvement of these commitments may lead to high-quality services.

To evaluate the performance of a program, it is necessary that human resources involved in the implementation evaluate the program as the main sources of information. Therefore, this study aimed to evaluate the performance of health care system reform plan in Yazd province from the perspective of university hospital executives.
This was a cross-sectional study in which all senior and middle managers of university hospitals in Yazd Province (n=53) were enrolled through census. The data were collected using a researcher-made questionnaire. Data analysis was performed by SPSS 20 using descriptive statistics, frequency, and percentages.
47.2% of the executives believed that health care reform plan had reached 60 to 79 percent of its goals. Only 7.5% of the managers believed that health care reform plan could not succeed in dealing with out-of-tariff cost. Human resources was reported as the most important problem by 48.1% and interaction with insurance as the least important problem in health care system reform plan by 9.2%. Finally, most of the managers believed that the instructions of reducing out-of-pocket were implemented significantly better than the former five instructions of health care system reform plan and it was beneficial in practice.
Achieving the objectives of health care system reform was evaluated as appropriate, however, the performance of some instructions was not as expected, hence the need for interventions in this area.

Hospitals, in extreme competition, have accepted principles of marketing designed for industrial goods and customers. One of the important factors in health services marketing is the type of services. Organizations, including health centers, require meeting the client's needs in order to survive and try to promote the way of providing services effectively. The present study aims to identify effective components in providing clinical services in hospitals.
This was a practical and cross-sectional study. Data were collected using a questionnaire completed through random sampling after confirming the validity and reliability. Data were analyzed by SPSS 21 and Lisrel 8.50 using descriptive statistics and factor analysis.
The results of this study indicated that nine components had the highest impact on providing health services. Confirmatory factor analysis showed that the quality of providing services in the hospital, offering distinctive services compared with other hospitals, and considering quality of service beyond the patient's expectation had the greatest impact on marketing services in the hospital.
Providing quality and distinctive services beyond the patient's expectation enables hospitals to improve their marketing activities and, beside higher level of patient satisfaction, develop their clinical services market share.

A structured error reporting system, has a warning and connecting role in practitioners in patient care. The aim of this study was to investigate the causes of medical errors in voluntary reporting system in hospitals of Mazandaran University of Medical Sciences in 2014.
This study is a cross-sectional study conducted in 2014. The population consisted of all the medical staff of hospitals affiliated to Mazandaran University of Medical Sciences. Data collection was conducted through review of medical errors reports. After classification, data were analyzed by Excell.
According to the results, during 6 months of 2014, 1927 cases of medical errors were reported of which 820 cases were in clinical wards, 550 in ICU, 76 in operating room, 401 in paraclinical wards, and 80 in other parts of the hospiral.
It is recommended to develop training programs for all employees to report medical errors. Aslo the findings of this study can help in planning for prevention of medical errors.

In organizational learning theory, organization is defined as an open system that has the ability to anticipate, identify, define, design, and solve its problems. This study was aimed to examine the relationship between organizational learning and organizational agility in the teaching hospitals of the city of Yazd.
This analytical and cross-sectional study was conducted in 2015 in four teaching hospitals of the city of Yazd. A total of 370 administrative and medical staff contributed in the study. We used stratified-random method for sampling. The required data were gathered using two valid questionnaires including organizational learning questionnaire (Neefe 2001) and organizational agility questionnaire according to the theory of Sharifi & Zhang (1999) being analyzed trough statistical softwares of R and lavaan package, semPlot and semtool for structural equation model and SPSS18 for descriptive statistics.
Our results showed a positive significant relationship between organizational learning and organizational agility (0.521).
Based on the findings it can be concluded that the implementation of appropriate strategies for improving the organizational capacity to direct its employees’ mental abilities, can improve the ability of organization’s rapid response to surrounding issues which is crucial for its survival and dynamics in today’s changing world.